A new arthroscopic approach for traumatic instability has been developed with which avulsed capsulolabral tissue can be effectively attached to the glenoid articular rim with sutures, providing anatomic reattachment and effective deepening of the glenoid concavity similar to that achieved by open repair. This technique does not depend on fixation devices, trans-scapular drilling, or implantation of suture anchors. The fixation of the labrum using the punch-chop needle overlap technique (Aeratec Inc, Uniondale, NY) for reattaching torn labral tissue to bone allows ease of suture placement for Bankart lesion repair, with the fixation overlapping the rim of the glenoid. The technique presented here includes preparation of the glenoid rim, drilling of the glenoid tunnels, and peripheral suturing of the labrum.
Overlap arthroscopic Bankart repair: reconstruction to the glenoid rim. (PDF Download Available). Available from: https://www.researchgate.net/publication/11416151_Overlap_arthroscopic_Bankart_repair_reconstruction_to_the_glenoid_rim [accessed Feb 14 2018].
This article presents an arthroscopic inferior capsular shift technique. In this technique, the same type of inferior capsular shift as with the open standard Neer procedure can be performed. After standard diagnostic shoulder arthroscopy, a bone trough is made along the capsular attachment to the humeral head using an abrader. An inverted L-shaped incision is performed in the anterior capsule. A suture is passed through the apex of this triangular flap, which is then pulled up and tied over the upper edge of the subscapularis, thus reducing the size of the wide anterior capsule. No hardware implants are used, and the procedure is not technically complicated. The surgery required fewer steps than open repair. The advantages of this technique are the preservation of the subscapularis, faster rehabilitation, and earlier return to normal activities, including sports. It also causes less postoperative range of motion limitation, while offering the same amount of capsular shift as the traditional open repair.
Arthroscopic Reinforced Capsular Shift of Anterior Shoulder Instability | Request PDF. Available from: https://www.researchgate.net/publication/8583584_Arthroscopic_Reinforced_Capsular_Shift_of_Anterior_Shoulder_Instability [accessed Feb 14 2018].
Neer and Foster’s open inferior capsular shift to treat acquired cases of anteroinferior shoulder instability due to an overstretched and redundant capsule is described with good results. Recently, new arthroscopic techniques were described to manage this problem. To assess the results of a new arthroscopic reinforced inferior capsular shift technique based on Neer and Foster’s open inferior capsular shift. Case series; Level of evidence, 4. This new technique of arthroscopic inferior capsular shift was used to treat 108 patients with anteroinferior shoulder instability due to capsular redundancy as confirmed clinically and during arthroscopy. It reduces the size of the redundant capsular pouch and reinforces the thinned-out capsule. Intraoperatively, patients with associated labral tears (n = 25) and patients with open rotator intervals (n = 8) were excluded, and only 75 patients with pure capsular redundancy were included in this study. Patients were followed for a minimum of 7 years. All 75 patients had patulous and redundant capsules. Three patients (4.0%) had a redislocation after a significant trauma. The range of motion preoperatively was 168.1° ± 7.5° in forward elevation, 64.7° ± 7.9° in external rotation, and T5.0 ± T0.8 in internal rotation. Postoperatively, it was 167.2° ± 5.8° in forward elevation, 59.95° ± 4.9° in external rotation, and T7.1 ± T1.0 in internal rotation. The American Shoulder and Elbow Surgeons (ASES) (70.76 to 97.53; P < .001), Constant (90.02 to 99.24; P < .001), and University of California, Los Angeles (UCLA) (21.97 to 33.84; P < .001) scores demonstrated significant improvement postoperatively. This novel technique of arthroscopic capsular shift addresses the problem of capsular redundancy present in many cases of anteroinferior shoulder instability. It tries to achieve a capsular shift based on the principles of Neer. The long-term results are very good.
Arthroscopic Inferior Capsular Shift Long-Term Follow-up | Request PDF. Available from: https://www.researchgate.net/publication/221903859_Arthroscopic_Inferior_Capsular_Shift_Long-Term_Follow-up [accessed Feb 14 2018].